+++
Definition of the Complaint
++
The term decreased activity level describes a wide spectrum of existence ranging from boredom to coma. The diagnostic evaluation focuses on encouraging parents to provide a detailed account, particularly with regard to the magnitude and time course of the changes. Clearly, the differential diagnosis of subtle behavioral changes developing during a period of several months differs from that of changes occurring during several hours.
+++
Complaint by Cause and Frequency
++
The causes of decreased level of activity in children vary according to age (Table 2-1), and can be placed into several broad categories (Table 2-2). Additional issues to consider include whether there is depressed sensorium indicating an underlying central nervous system (CNS) disorder, weakness indicating a muscular disorder, or endurance problems suggesting a cardiac or pulmonary issue. Systemic illness may manifest with somnolence or lethargy.
++++
++
The patient who presents for evaluation of decreased level of activity represents a broad differential. Several important historical questions can help classify the underlying etiology:
++
- What is the time course of decreased level of activity?
- Infectious etiologies typically present during a shorter time course than do other etiologies, such as iron deficiency anemia or certain types of CNS malignancies.
- Is the patient febrile?
- Fever, from an infectious etiology, can cause a decreased level of activity in children. However, hypothermia, particularly in neonates, can ...